Availity provides administrative services to BCBSIL. The alpha prefix is very important to the identification number. Note for Front Desk and Providers: When Blue Cross Blue Shield members comes to your facility or office, make sure to ask them for their active BCBS plan member ID card. To view this file, you may need to install a PDF reader program. In addition to verifying membership/coverage status and other important details,this step returns information on prior authorization requirements and utilization management vendors, if applicable. Also, these BCBS prefixes helps providers and medical billers to reach the correct claims department for claims and benefits inquiry. Compliance, Fraud, Waste and Abuse Program and Reporting: HCSC and its subsidiaries are founded on the basic principles of good business behavior. The BCBSIL Commercial Provider Manual is organized into the following sections for providers participating in PPO, Blue Choice PPOSM, HMO and the Blue High Performance NetworkSM(Blue HPNSM)EPO. xyl prefix provider phone number aqt bcbs prefix bcbs of minnesota prefix bcbs prefix lookup anthem prefixes by state 2022 bcbs illinois prefix list 2022. We are also the largest provider of health benefits in Illinois, serving more than 8.1 million members in all 102 counties across the state. Prefixes are also used to identify and correctly route claims to the appropriate Blue Cross Blue Shield [] Prefixes are also used to identify and correctly route claims to the appropriate Blue Cross Blue Shield [] Home plans are generally used as a member of the former application. It covers the plans based on associating them with the testing, measuring the protocols at the time of the trip and many more. eviCore healthcare (eviCore) is an independent company that has contracted with BCBSIL to provide prior authorization for expanded outpatient and specialty utilization management for members with coverage through BCBSIL. IPA Availability and Accessibility Requirements for Immediate Care Services Procedure. Manage Settings Also its not a sequential order hence its hard to find unless we check with first 3 alpha prefix. Click on New Document and select the file importing option: upload Xxu blue cross prefix from your device, the cloud, . Bcbs prefix list is showing the exact BCBS plan of the patient, so you can easily call to exact location plan and handle AR follow-up effectively. The policies and regulations provided by the organization convey great statements and activities into the proper placement. %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz Account Specific Prefix are assigned by BCBS to national accounts. BCBS member ID have maximum 17 characters but most of the member IDs have 12 characters. Any individuals who impact HCSC's Medicare or Medicaid contract(s) are expected to abide by the Medicare and Government Contracts Compliance Program, the Code of Business Ethics and Conduct and the Medicare Compliance Policies. from the date of service. $TbYmVcI^ONr#H2.G uG!`;4%x$;L[| <>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S>> -x0cjH4`f4`c:A 9K+)tnapM"f2:d+-%0|[FpPDRtZd)@@0,4|(a8`0XE3Fx"K@dd`vF[VgGs.OO'wAl~B~P%sr:|7Rz For Example: ABC, A2B, 2AB, 2A2 etc. Prior authorization requests for our Blue Cross Medicare Advantage (PPO)SM(MA PPO), Blue Cross Community Health PlansSM(BCCHPSM) and Blue Cross Community MMAI (Medicare-Medicaid Plan)SMmembers can be submitted to eviCore in two ways. The content shared in this website is for education and training purpose only. endobj Calls will be returned the next . BCBS prefix list EAA-EZZ. The insurance company also provides facilities for the senior citizens and claims to give the best facilities for them and get them admitted to the nearest hospital. Address: 11070 Katy Fwy, Houston, TX 77043, 2023 Xceed Billing Solution.com - All Rights Reserved. endobj It is one of the giant sectors that provide more than 106 million health facilities. On the other hand, host plans indicate more services in the health care services and competition within the area. BCBS Prefix should be included along with ID number, exactly as it appears on the member ID card when filing the claims to insurance company. The 34 independent BCBS companies insure more than 107 million members across all 50 states, the District of Columbia, and Puerto Rico. endobj XCD. It means that BCBS members IDs prefix will must have alphabets and they may or may not have numbers. Blue Cross and Blue Shield of Illinois (BCBSIL) members' ID cards in the BlueCare Direct and Blue Choice Preferred PPO plans have . X2A to X9Z. The Blue Cross helps to deal with the coverage of finding out medical costs and other emergencies. Blue-Cross Blue-Shield of Illinois. Amerihealth Caritas Directory Healthcare, Health Insurance in United States of America, Place of Service Codes List Medical Billing, Independence Blue-Cross of Philadelphia and Southeastern Pennsylvania, Maryland/District of Columbia/Northern Virginia, Anthem Blue-Cross Blue-Shield of Virginia, Excellus Blue-Cross Blue-Shield of New York, Anthem Blue-Cross Blue-Shield of Missouri, Blue-Cross Blue-Shield of Western New York, Empire Blue-Cross Blue-Shield of New York, Anthem Blue-Cross Blue-Shield of Colorado, Anthem Blue-Cross Blue-Shield of Wisconsin, Highmark Blue-Cross Blue-Shield of Pennsylvania, Horizon Blue-Cross Blue-Shield of New Jersey, Anthem Blue-Cross Blue-Shield of Connecticut, Anthem Blue-Cross Blue-Shield of Kentucky. T2A to T9Z. Prior authorization isrequiredfor some members/services/drugsbefore services are rendered to confirm medical necessity as defined by the members health benefit plan. Most PDF readers are a free download. Curious to know what are national Accounts? Learn more. The consent submitted will only be used for data processing originating from this website. BCBS Alpha Prefix from BAA to BZZ. BCBS of Kansas City. Most of the coverages are associated with baggage loss. Returning Shopper? Learn more about Ezoic here. How To Identify Blue Cross Blue Shield Member? These BCBS prefix may include alpha and numerical characters. The presence of the members in the organization deals with decisions on certain critical conditions of the customers and getting steps to solve the issues. Among these principles are a commitment to the highest standard of business ethics and integrity. The manual is organized into the following sections for your convenience. External link You are leaving this website/app (site). M+. For more than 85 years, weve provided our members with comprehensive, affordable health plans, making Illinois a healthier place to live, work and play. Insurance Identifier Lookup; Plan Phone Numbers; Medicare Contractors; State Medicaid Plans; Home; Medicare Advantage List; . When does health insurance expire after leaving job? <> HOME; . There are two types of BCBS prefixes which are mentioned below: Plan Specific prefix are assigned by BCBS to each plan. <> Note: BCBS FEP (Federal Employee Program) ID starts with the alphabet R follow by the insured ID number (For Example: R987654321). Example: Prefix ZGP (Blue Cross Blue Shield of Texas it is a PPO Product). Policy number is a unique number, which is provided to their insured person by respective insurances in order for identification purposes and also for billing the healthcare claims. Make sure to make copies of the front and back of member ID card. For example: ABC12345678. 11 0 obj Provider Finder . If you have questions on a request handled by BCBSIL, contact our Medical Management department. BCBS is the biggest private insurance company in the United States after federal insurance and there are hundreds of BCBS plans according to state and geographical areas. Blue Cross Blue Shield Federal Phone Number. Language Assistance (opens in a new window) and Non-Discrimination Notice . 365days . <> The main benefits of having insurance plans and coverages are not only getting monotonous services but also enjoying the perfect scheduling of other facilities, i.e., international travel and coverages. BCBS Alpha Prefix List from UAA to UZZ Updated 2023. XCE. For more than 85 years, we've provided our members with comprehensive, affordable health . By doing it may cause delay in processing or handling the claim. One option is Adobe Reader which has a built-in reader. However it has several policies for its customers. Always make sure to submit claims to insurance company on time to avoid timely filing denial. <> The site may also contain non-Medicare related information. BCBS Prefix will not only have numbers and the digits 0 and 1. An example of data being processed may be a unique identifier stored in a cookie. endstream Do not delay the billing of a claim for any reason. The information you're accessing may not be provided by Excellus BCBS. The blue cross blue shield coverage deals with the best services for its customers and involves a better statement of the medical treatments. BAA. So, to accomplish our goal, we have listed down the complete BCBS alpha prefix list so that you can easily identify correct BCBS plan. 1 0 obj Ohio. 2021 Commercial Specialty Pharmacy Prior Authorization Drug List This list was updated with 14 new codes effective Jan. 1, 2021. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors. Health Equity and Social Determinants of Health (SDoH), Over the Counter Equivalent Exclusion Program, Prior Authorization and Step Therapy Programs, Consolidated Appropriations Act & Transparency in Coverage, Medical Policy/Pre-certification: Out-of-area Members, Behavioral Health IP PA - IVR Caller Guide, Behavioral Health OP PA - IVR Caller Guide, Inpatient Preauthorization - IVR Caller Guide, Outpatient Preauthorization - IVR Caller Guide, Preauthorization: Check Request Status - IVR Caller Guide, Utilization Management Process Overview (Commercial), Patients medical or behavioral health condition, Date of service, estimated length of stay (if the patient is being admitted), Provider name, address and National Provider Identifier (NPI), Government Programs 877-774-8592 (MA PPO); 877-860-2837 (BCCHP); 877-723-7702 (MMAI). Availity is a trademark of Availity, LLC., a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Note: Most out-of-network services require utilization management review. <> Denials with solutions in Medical Billing, Denials Management Causes of denials and solution in medical billing, CO 4 Denial Code The procedure code is inconsistent with the modifier used or a required modifier is missing, CO 5 Denial Code The Procedure code/Bill Type is inconsistent with the Place of Service, CO 6 Denial Code The Procedure/revenue code is inconsistent with the patients age, CO 7 Denial Code The Procedure/revenue code is inconsistent with the patients gender, CO 15 Denial Code The authorization number is missing, invalid, or does not apply to the billed services or provider, CO 17 Denial Code Requested information was not provided or was insufficient/incomplete, CO 19 Denial Code This is a work-related injury/illness and thus the liability of the Workers Compensation Carrier, CO 23 Denial Code The impact of prior payer(s) adjudication including payments and/or adjustments, CO 31 Denial Code- Patient cannot be identified as our insured, CO 119 Denial Code Benefit maximum for this time period or occurrence has been reached or exhausted, Molina Healthcare Phone Number claims address of Medicare and Medicaid, Healthfirst Customer Service-Health First Provider Phone Number-Address and Timely Filing Limit, Kaiser Permanente Phone Number Claims address and Timely Filing Limit, Amerihealth Caritas Phone Number, Payer ID and Claim address, ICD 10 Code for Sepsis Severe Sepsis and Septic shock with examples, Anthem Blue Cross Blue Shield Timely filing limit BCBS TFL List, Workers Compensation Insurances List of United States, Workers Compensation time limit for filing Claim and reporting in United States. An Independent Licensee of the Blue Cross Blue Shield Association 020469 (03-01-2023) Prefix BCBS Plan Prefix BCBS Plan Prefix BCBS Plan A2T Premera Blue Cross A9P Premera Blue Cross ACF Premera Blue Cross AGL Premera Blue Cross/Shared Admin GUJ AHC Premera Blue Cross AJX Premera Blue Cross GVY ALK Premera Blue Cross BCBS National accounts are employer groups that have outlets/offices in multiple states but they offer limited coverage to their employees. giV7Lxp^^YM(_{27e;//3_`|eC9EliUDD.3fJ0]6DT{,dMZRPRWN2C7?HL4fvy|\b%^SKwIOh)xo${A%t7A3_h}AL Health Equity and Social Determinants of Health (SDoH), Over the Counter Equivalent Exclusion Program, Prior Authorization and Step Therapy Programs, Consolidated Appropriations Act & Transparency in Coverage, Medical Policy/Pre-certification: Out-of-area Members, HMO Medical Service Agreement Highlight and Process Summary, 3rd Trimester Pregnancy IPA Transfer Policy, 3rd Trimester Pregnancy IPA Transfer Procedure, Ancillary Hospital Institution Care Transition Exceptions Policy, Ancillary Hospital Institution Care Transition Exceptions Procedure, Contract Management Firms Confidentiality Agreement Policy, Contract Management Firms Confidentiality Agreement Procedure, Corrective Action for Failed Utilization Management Audit of Participating IPAs Policy, Corrective Action for Failed Utilization Management Audit of Participating IPAs Procedure, Collaborative Improvement Coaching for HMO Quality Improvement Projects Policy, Collaborative Improvement Coaching for HMO Quality Improvement Projects Procedure, IPA Availability andAccessibility Requirements forImmediate Care Services Policy, IPA Availability andAccessibility Requirements forImmediate Care Services Procedure, IPA Guidelines for Member Complaints, Inquiries, Appeals and Grievances Policy, IPA Guidelines for Member Complaints, Inquiries, Appeals and Grievances Procedure, IPA Process for Establishing Out of Area for Emergency Services Policy, IPA Process for Establishing Out of Area for Emergency Services Procedure, IPAs Request for Member Transfer Procedure, Member Access to Behavioral Health Services Policy, Member Access to Behavioral Health Services Procedure, Member Notification Process when a Provider Leaves the IPA Policy, Member Notification Process when a Provider Leaves the IPA Procedure, Oversight of Contracted Infertility Vendor Policy, Oversight of Contracted Infertility Vendor Procedure, Primary Care Physician (PCP) Affiliation with Multiple IPAs Policy, Primary Care Physician (PCP) Affiliation with Multiple IPAs Procedure, Utilization Management and Case ManagementAdherence Audit of Participating IPAs Policy, Utilization Management and Case ManagementAdherence Audit of Participating IPAs Procedure, Accountable Care Organization (ACO) Dual Claimed Physician Policy and Procedure, BCBSIL Marketing Communications HLA Policy Procedure, Blue Cross Blue Shield of Illinois Quality of Complaints & Occurrences Process Policy, Blue Cross Blue Shield of Illinois Quality of Complaints & Occurrences Process Procedure, Provider Handling of Member Inquiries Complaints and Appeals, Provider Urgent/Expedited Clinical Appeal Process, Recovery of Provider Overpayments due BCBSIL, MA HMO Detailed Explanation ofNon-coverage, MA HMO Notice of Dismissal of Organization Determination Request, MA HMO UM Approval In Network ProviderLetter, MA HMO UM Approval Out of Network ProviderLetter, MA HMO Sample Provider Appeal Language for Explanation ofPayment, MA HMO Sample Waiver of LiabilityStatement, MA HMO Transition to Transplant ManagementForm, HMO Provider Credentialing Pre-application. . Anthem Blue-Cross Blue-Shield of Ohio. Complete Guideline and Strategy, Tips to Create the Perfect Medical Provider Resume, Benefits and Eligibility Verification Services. Carefirst BCBS of Maryland the (MD), District of Columbia (DC), and the Northern Virginia (VA) CAB. <> Medicare Advantage is an alternative to original Medicare where a private health insurance . The following travel insurance helps to deal with all the medical costs and also covers the family expenses. Unassigned Prefix. 4 0 obj Coupon "NSingh10" for 10% Off onFind-A-CodePlans. This list of bcbs prefixes includes BC prefix YUP, YRK, YPN, YPJ, YTD, YRH, YTP, YIF. Always check eligibility and benefits first,via theAvailityEssentialsor your preferred web vendor, prior to rendering care and services. The plans and system go on covering up the international travel ventures. BCBS is one of the biggest insurance companies in USA and serving more than 106 million people. Ans. To viewrequirements summaries andprocedure code lists, refer to theSupport Materials (Commercial)andSupport Materials (Government Programs)pages. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. We offers a wide range of RCM solutions to improve your healthcare services financial health and allows you to focus on patients care rather than collecting payments from insurances and patients for services performed. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. BCBS Alpha prefix and BCBS Alpha numeric prefix are very important to submit claims to BCBS insurance. 800-676-2583. We are also the largest provider of health benefits in Illinois, serving more than 8.1 million members in all 102 counties across the state. |d&`{ ^^I|Wp:K|~._s N9=*io1*sLxfLf9`El/Ou:!fUKc3'I"UIcL 0 d.|XbY!&e|&1'b[7N!B!axHgY&K8Ugxl ]j.,pj,$&GHox Request a new replacement member ID card, or download a temporary copy. Choose a state to see how Blue Cross Blue Shield is working in your community. Contact us to learn how we can improve your revenue cycle. Member Prefix List Patient Roster Claims & Payments. Denials with solutions in Medical Billing, Denials Management Causes of denials and solution in medical billing, CO 4 Denial Code The procedure code is inconsistent with the modifier used or a required modifier is missing, CO 5 Denial Code The Procedure code/Bill Type is inconsistent with the Place of Service, CO 6 Denial Code The Procedure/revenue code is inconsistent with the patients age, CO 7 Denial Code The Procedure/revenue code is inconsistent with the patients gender, CO 15 Denial Code The authorization number is missing, invalid, or does not apply to the billed services or provider, CO 17 Denial Code Requested information was not provided or was insufficient/incomplete, CO 19 Denial Code This is a work-related injury/illness and thus the liability of the Workers Compensation Carrier, CO 23 Denial Code The impact of prior payer(s) adjudication including payments and/or adjustments, CO 31 Denial Code- Patient cannot be identified as our insured, CO 119 Denial Code Benefit maximum for this time period or occurrence has been reached or exhausted, Molina Healthcare Phone Number claims address of Medicare and Medicaid, Healthfirst Customer Service-Health First Provider Phone Number-Address and Timely Filing Limit, Kaiser Permanente Phone Number Claims address and Timely Filing Limit, Amerihealth Caritas Phone Number, Payer ID and Claim address, ICD 10 Code for Sepsis Severe Sepsis and Septic shock with examples, Anthem Blue Cross Blue Shield Timely filing limit BCBS TFL List, Workers Compensation Insurances List of United States, Workers Compensation time limit for filing Claim and reporting in United States. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Xceed Billing Solutions is amedical billing company for outsourcing medical billing services. BCBS Prefix BCBS Plan Name E2A Blue Cross Blue Shield Texas E2B Blue Cross Blue Shield Texas E2C Anthem BCBS Indiana E2E Regence Blue Cross . Normally, account specific prefix associates to the employer group name. CAA. endobj I have completed my Bachelor of Business Administration in Healthcare Management from University of Texas. October 1, 2022 by Rebecca Williams. 2/1/2023. stream BCBS prefix are easy to identify using our BCBS prefix lookup because theyre part of every BCBS member ID and we included all of them here in the BCBS prefix list. !D)v&GVr`&dq:1+{maO1DmP[ +|zUma-lT *5+J&E k$T46Bt^:+~/ES" Health Exchange. IPA Guidelines for Member Complaints, Inquiries, Appeals and Grievances Policy. Medical Billing and Coding Information Guide. LAA. Prefix ZGP identifies Blue Cross Blue Shield of Texas PPO Product. 14 0 obj BCBS Alpha prefix and BCBS Alpha numeric prefix are very important to submit claims to BCBS insurance. If youre a medical biller or a provider and going to submit BCBS plan member claim to the insurance, make sure to submit member ID including prefix. If the provider or member doesnt get prior authorization for out-of-network services, the claim may be denied. Step-by-Step Guide for Provider Finder . endobj We have a track record of providing quality medical billing services to multiple healthcare organizations and specialty providers across USA. This includes strict observance of and compliance with the laws and regulations governing the business operations of HCSC, and in particular, the services that it performs or has delegated to others to perform pursuant to its Medicare and Medicaid contract(s). BCBS Alpha Numeric Prefix from W2A to W9Z (Updated 2023) January 8, 2023 by Kim Keck. Step 1 Confirm if Prior Authorization is Required. It also suggests that the members enjoy the networks participating with the hospital and other medical costs. 7 0 obj For . The Home and Host plan is also working in the Blue Cross Blue Shield plan. For providers and medical billers who are performing medical billing services, BCBS alpha prefix are helpful to identify the correct payer ID and address for claims submission. Prime Therapeutics LLC (Prime) is a pharmacy benefit management company. In general, there arethreestepsprovidersshould follow. BCBS is one of the largest medical insurance company by total members of more than 45 million. For Example: ABC, TXX, TEA, A2B, 2AB, 2A2, PAS, XXU etc. BCBS Alpha Prefix List of "E"-series: Blue Cross Blue Shield insurance Companies - Statewise: EAA: Not assigned prefix: EAB: BCBS of Kansas City: EAC: Anthem BCBS of Virginia (VA) EAD: BCBS of Illinois (IL) EAE: Regence BCBS: EAF: BCBS of Massachusetts (MA) EAG: Capital Blue Cross of Pennsylvania (PA) EAH: BCBS of Alabama (AL) EAI: Not . It allows you to quickly and easily identify your insurance home plan, saving you time and hassle. 10 0 obj Most of the expenses get exposed through the treatments, and for that, the coverages are built up. In order to get rid of this denial or sometimes delay in processing, Provider or Billing companies has to find out the correct address by BCBS prefix from the above list before filing the claim. Prior authorization requests for our Blue Cross Medicare Advantage (PPO) SM (MA PPO), Blue Cross Community Health Plans SM (BCCHP SM) and Blue Cross Community MMAI (Medicare-Medicaid Plan) SM members can be submitted to eviCore in two ways. Some requests are handled by BCBSIL; others are handled by utilization management vendors. So the next time you need to identify accurate BCBS prefix home plan, remember to use the BCBS prefix list lookup finder. Final Instructions about BCBS Prefix Lookup, United Healthcare Claims Address Information, BCBS Alpha Numeric Prefix from U2A to U9Z (Updated 2023), BCBS Alpha Prefix from TAA to TZZ (Updated 2023). Preferred PPOSM Alpha Prefix Codes December 15, 2015 As a reminder, the alpha prefix codes on Blue Cross and Blue Shield of Illinois (BCBSIL) members' ID cards in the BlueCare Direct and Blue Choice Preferred PPO plans have been updated. Here I have shared the list of BCBS alpha prefix ranging from BAA to BZZ. Every Blue Cross and Blue Shield plan starts with an alpha prefix so they are called in medical terms BCBS Alpha Prefix. Once a prior authorization request is received and processed, the decision is communicated to the provider. To run such a large number of people, they divided Blue Cross Blue Shield Insurance Association into different departments which is employer specific or state wise. <> Usually, the provider is responsible for requesting prior authorization before performing a service if the member is seeing an in-network provider. In addition, some sites may require you to agree to their terms of use and privacy policy. If possible, make copies of the member's ID card (front and . Ans. W2A to W9Z. BCBS Alpha Prefix List from GAA to GZZ updated 2021-List of Blue Cross Blue Shield insurance Companies - Statewise with prefix. A Google Certified Publishing Partner. Emergency services are an exception. Five most Workers Compensation Mistakes to Avoid in Maryland. PUJyf\P )} 9\7R8lSJ|y:mYY p!+uUxSACJQ;,#3X_xR The first two alphabets of the prefix denote the plan and the third alphabet prefix denotes the type of product the insured choose for coverage. In this way, the BCBS holds on compensating the costs and indulges with the maximum support of the customers. It also goes on dealing with the student plan. BCBS FEP Prefix BCBS Federal Employee Program is identified by the letter R followed by the number. stream One of the biggest issues in todays generation is where medical treatments and conditions lie. endobj knowledge of BCBS alpha prefix is compulsory if you are handling denials and AR follow up. September 30, 2022 by Rebecca Williams. Health Care DeliveryPolicy and Procedures, Blue Cross Community Health Plans ProviderManual, Medicaid Provider Orientation(Professional), Medicaid Prior Authorization RequestForm, Medicaid Provider Orientation (Professional), Blue Cross Community OptionsSMBehavioral Health Benefit Grid.
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